Dual-Screw Fixation for Chronic Syndesmotic Injury: A Case Report.

INTRODUCTION

Ankle syndesmotic injuries present a major challenge due to their high biomechanical complexity and high risk of instability if not properly managed. There remains a controversy between the use of single versus double-screw fixation, Tight Rope fixation, arthrodesis, and ligament reconstruction, particularly in chronic or high physical demand cases.

CASE REPORT: A 25-year-old male presented to our trauma center after sustaining a bimalleolar fracture of the left ankle with chronic syndesmotic injury, lasted for 5 months, after a motorcycle accident. Initially, open reduction with internal fixation and single syndesmotic screw fixation was done. However, anterior subluxation of the syndesmotic joint was evident on computed tomography scan post-operatively, which necessitated revision surgery, after 1 week, with dual screw fixation to restore joint alignment.

CONCLUSION

Dual-screw syndesmotic fixation provided superior outcomes in comparison to single-screw in patients with chronic injury and high-instability risk. This approach, if routinely done in selected cases, may reduce the incidence of recurrent instability and therefore the need for revision surgeries, as well as improve long-term functional outcomes.